Question:
I’ve got dark circles and hollowness under my eyes. Can fat transfer be used to improve this and is it safe?

Answer:
Fat transfer can definitely improve the hollowness under the eyes and in turn then the dark shadows that occur due to the hollowness will also be improved.  There has also been a side effect noted in the skin after fat transfer in that the skin ends up getting rejuvenation as well and this may be due to the stem cells that are in fat that we transfer.  Ultimately, I would have to evaluate your particular anatomy as to whether or not fat transfer alone would be your best option or if I would recommend a lower lid blepharoplasty in conjunction with fat grafting to give you the best result.  Some patients would also benefit from cheek implants if they really need a large amount of volume in the cheek and mid-face area.  

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Question: I know eyelid surgery is sometimes performed for medical reasons if sagging upper eyelids interfered with vision. Is this ever true for browlift surgery?

Answer: Occasionally a patient will have such low-set brows that a standard blepharoplasty alone is not going to be able to completely improve their visual deficit.  In that case, a browlift in conjunction with the blepharoplasty may be covered by insurance though frequently it can be difficult to get the insurance company to pay for that treatment.

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Question: What is a lower eyelid “skin pinch”?

Answer: Lower eyelid skin pinch is a procedure where excess skin is removed in the lower eyelids.  This is typically performed in patients who do not have true bags in the lower eyelids, but they have a significant amount of wrinkling due to redundant skin.  The procedure is performed as it is described where local anesthetic is placed under the skin and then a small device is used to pinch the skin allowing us to determine exactly how much excess skin is safe to remove.  This excess skin is then removed and very fine sutures are placed to close this small incision.  The sutures are removed in three or four days and the resulting scar is just below the eyelashes and once healed is exceptionally inconspicuous.

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Question: I keep hearing about something called laser blepharoplasty. Can you explain what this is? Is it still surgery?

Answer: A laser blepharoplasty is a relatively standard blepharoplasty procedure that simply uses a CO2 Laser to make some of the incisions and to help with coagulation.  I have not seen any good head-to-head studies showing a significant advantage using a laser and, in fact, theoretically the CO2 Laser will actually cause surrounding thermal injury that would be unwanted in most circumstances and I, therefore, continue to employ a more standard approach of using a very fine scalpel for skin incisions and super sharp scissors for any tissue treatment under the skin.  A jeweler’s forceps bipolar cautery is used to precisely control any very minor bleeding and this, therefore, limits the surrounding injury and tissue damage and, in my opinion, allows for a faster recovery.  The majority of my patients look quite good in three to four days when their sutures are removed.

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Question: I’d like to know a little bit more about post eyelid surgery healing. Is the recovery process relatively easy?

Answer: Recovery after eyelid surgery is overall relatively easy.  Patients just need to ice the eyes as much as possible for the first two to three hours and then once an hour after that until they go to bed that evening.  They should sleep in an elevated position so that their shoulders are higher than their hips.  This will help reduce any resulting bruising and swelling that they would see the next day; otherwise, discomfort is typically rather minimal and is usually relieved by ice on the eyes.  I personally remove sutures in three to four days and by then a significant amount of the bruising and swelling is already resolved.  Most patients can then place a small amount of cover makeup on these areas and resume relatively normal activities though I recommend that they avoid strenuous activities for about two weeks. 

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